Reducing and Eliminating Seclusion & Restraint: The Leadership Factor THE SAKS SYMPOSIUM University of Southern California Gould School of Law April 22-23, 2011

 In US, an estimated 50 to 100 people die each year as a result of S & R and many more are traumatized or injured.  Research now demonstrates that psychological harm, physical injuries and death are by-products of S&R.  Research also demonstrates that injury rates to staff in mental health settings using S & R have been found to be higher than those found in high-risk settings like lumbar, construction and mining.  Reducing harm and promoting recovery requires a shared vision of success, a clear mission and leadership at all levels. The Curie Group, LLC, April

 The efforts to reduce seclusion and restraint must be grounded to the greater vision of the organization.  Vision Definition:  The ultimate outcome of how the world should be as a result of your efforts. The Curie Group, LLC, April

 A vision is realized through accomplishing a mission.  A mission is a clear statement of what you will do in order to attain a vision. The Curie Group, LLC, April

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6 VISIONMISSIONPRIORITIESGOALS OUTCOME METRICS

 SAMHSA convened a national summit in December 2004 with 110 expert panelists  Issued National Consensus Statement on Mental Health Recovery “Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.” Source: The Curie Group, LLC, April

National summit also issued… The 10 Fundamental Components of Recovery  Self-Direction  Individualized and Person-Centered  Empowerment  Holistic  Non-Linear  Strengths-Based  Peer Support  Respect  Responsibility  Hope Source: The Curie Group, LLC, April

 Recovery is an individualized journey.  Recovery is a process and an outcome.  Recovery is  managing one’s illness =  managing one’s life. The Curie Group, LLC, April

Recovery = A life in the community. The new framing for public policy and finance. The Curie Group, LLC, April

The Curie Group, LLC, April

 Consumers define their own recovery journey in terms of the pursuit of goals, a decent place to live and connectedness to others.  If central to the concept of recovery is realizing certain goals to be a full participant in the community, then those goals should be the basis of outcome measures. The Curie Group, LLC, April

SAMHSA National Outcomes Measures (NOMS)  Reduced Morbidity  Employment/Education  Crime and Criminal Justice  Stability in Housing  Social Connectedness  Access/Capacity  Retention  Perception of Care  Cost Effectiveness  Use of Evidence-Based Practices Source: The Curie Group, LLC, April

The Curie Group, LLC, April “I love it when a plan comes together !” ~John “Hannibal” Smith, The A-Team

 1997, PA DPW/OMHSAS issued the challenge to reduce/eliminate S & R in 9 state hospitals.  The Issues: ◦ Research demonstrated S&R not working ◦ Recovery rates low ◦ Most patients already victims of trauma ◦ No need to reinforce that trauma or retraumatize. ◦ If goal is recovery, patients need to be an active part of the process. The Curie Group, LLC, April

 Committed Leadership – Tied to Vision  Alignment with Mission - Recovery and CQI  Integrated system planning and implementation  Value driven, evidence-based priorities  Dissemination of evidence-based technology to define clinical practice and program design.  True partnership between all levels of the system  Data-driven, incentivized, and interactive performance improvement practices. The Curie Group, LLC, April

 Results ◦ Within 3 years:  Incidences of S&R down by 74%.  Patient hours spent in seclusion down 96%. ◦ AND  No increase in staff injuries.  Changes implemented without additional funds, using existing staff and resources. The Curie Group, LLC, April

 PA set the highest standards of S/R in the US.  Recipient of Harvard University/Ford Foundation/Council of Effective Government Innovations in American Government Award.  Not alone in its success. NASMHPD a key leadership partner. The Curie Group, LLC, April

 Mental health authorities in 8 states received 3-year State Incentive Grants to implement a model based on the Six Core Strategies for Reducing Seclusion and Restraint which are similar to what was used in PA.  20 of 28 facilities that reached stable implementation of the model were able to reduce seclusion hours by an average of 19% (per 1000 treatment hours).  Over half of the 28 facilities were able to reduce restraint hours by 55% (per 1000 treatment hours) on average. The Curie Group, LLC, April

 Vision and Leadership are essential ingredients to reducing seclusion and restraint in medical facilities.  From federal agencies to state agencies to hospital directors to department heads and mental health team leaders, the greater the alignment of vision and mission, the greater chances for success. The Curie Group, LLC, April

Our main business is not to see what lies dimly at a distance, but to do what lies clearly at hand. ~ Thomas Carlyle The Curie Group, LLC, April